ORIGINAL RESEARCH ARTICLE Clinical treatment of chronic and episodic migraine with onabotulinumtoxinA in a real-world setting Fernando Velasco-Juanes 1 • Juan Carlos Go ´mez-Esteban 1 • Tamara Ferna ´ndez-Valle 1 • Alexandra Matute-Nieves 1 • Javier Almeida-Velasco 1 • Mar Irida Lloret-Villas 1 • Iratxe Ugarriza-Serrano 1 Ó Springer International Publishing AG, part of Springer Nature 2018 Abstract Introduction OnabotulinumtoxinA (OnabotA) appears to be an effective prophylactic treatment for chronic migraine (CM), but its use in patients with episodic migraine (EM) has been little explored. We set out to assess the clinical efficacy of OnabotA in a real-life setting, focusing partic- ularly on EM patients. Methods This is a longitudinal, prospective, single-center analysis of 115 migraine patients [70 with CM, 21 with low-frequency EM (LFEM), and 24 with high-frequency EM (HFEM)] who received OnabotA in routine clinical practice in 2005–2015. In this study, the dosage regimen, the number of headaches, impact on quality of life (HIT-6 impact test) and the adverse events were among the parameters assessed. Results OnabotA treatment significantly reduced the number of headaches experienced by CM and EM patients, also increasing the number of responders ( [ 50% reduction in headache days). The quality of life of EM patients improved significantly, reducing the HIT-6 scores in both LFEM and HFEM patients. Adverse events were reported in 40% of patients, always mild and transient. Conclusions OnabotA is an effective and safe prophylactic treatment for migraine in routine clinical practice. It sig- nificantly improves a patients’ quality of life, particularly that of those suffering from CM and HFEM. Introduction Migraine is a common neurological disorder with an esti- mated global prevalence of 14.7%. It represents the leading cause of disability among neurological disorders [1] and, according to the World Health Organization (WHO), it is the 19th global cause of disability and the sixth most dis- abling disease [2]. Migraine affects three times more women than men; mostly individuals aged 35–45 years [3], imposing significant stress on patients, families, employers and society. Indeed, migraine sufferers experience a sub- stantial loss in functioning and productivity, which dete- riorates their quality of life (QoL), and produces a substantial economic burden on healthcare systems and employers [2, 4, 5]. Accordingly, with associated costs amounting to €27 billion in the EU [4], migraine is clearly an important public-health concern that possibly exerts the strongest economic burden among neurological disorders. Migraine treatment involves acute and preventive ther- apy. Acute treatment aims to reverse attacks, reducing the associated pain and disability, whereas preventive treat- ment should reduce the frequency, duration and severity of migraine attacks. Effective migraine management should involve both acute and preventive treatment, particularly when attacks are frequent and/or disabling, or when acute treatment fails. Several drugs are available for acute migraine treatment and there are numerous preventative therapies, including ß-blockers, amitriptyline and anti- epileptic drugs (e.g., topiramate and valproate). Other treatments are generally less efficacious or produce worse adverse effects (AEs: e.g., selective serotonin reuptake inhibitors, calcium channel antagonists, gabapentin and herbal medicines). Such treatments must be tailored to the individual based on their clinical features and any co- & Fernando Velasco-Juanes Fernando.velascojuanes@osakidetza.eus 1 Neurology Department, Hospital Universitario Cruces, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain Drugs Ther Perspect https://doi.org/10.1007/s40267-018-0511-5